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States with the highest rates of uninsured residents are among the least likely to have expanded Medicaid or to establish state-based exchanges under the Patient Protection and Affordable Care Act.

That is the conclusion that Gallup pointed to Friday in sharing the results of its latest analysis of how Obamacare is changing health care in the U.S. Yet even with the reluctance of many red states to throw their support behind healthcare reform, Gallup said it has seen evidence that the act is slowly but surely taking hold.

Gallup found that four of the five states with the highest percentage of citizens without health insurance — Texas, Florida, Louisiana and Mississippi — haven’t expanded Medicaid coverage or created a state insurance exchange. Arkansas, the other state on that list, has expanded Medicaid and set up an exchange, thus potentially setting itself up to be voted out of that club.

The trend spotted by Gallup doesn’t just apply to those in the top five. When it looked at the dozen states with the highest uninsured rates, it found that eight of them hadn’t taken any steps to embrace healthcare reform.

“While a majority of Americans continue to disapprove of the law, preliminary data suggest that its intended effects are beginning to occur, with a small decline in the percentage who are uninsured reported in mid-January. And, for the first time since October, when Gallup began regularly tracking uninsured Americans’ plans for getting insurance, a majority of the uninsured now plan to get their insurance from exchanges.”

The act’s real stronghold can be found — surprise, surprise — among blue states.

“In contrast to the states with the highest rates of uninsured residents, the 11 states with the lowest percentage of uninsured are considerably more likely to have already approved Medicaid expansion and state exchanges,” Gallup reported. “All five states with an uninsured rate below 10 percent – Massachusetts, Hawaii, Vermont, Minnesota, and Iowa – have elected to do so. Pennsylvania, Wisconsin, and Kansas are the three of the 11 that have not.”

What Gallup has provided is yet further evidence that the U.S. Constitution’s protection of states’ rights is still functioning more or less as intended. Where Republicans hold sway and state services are relatively low, Obamacare continues to get the cold shoulder. As states get bluer, adherence is truer.
Gallup drew some conclusions from its survey based on data from 178,068 U.S. adults ages 18 and over. Its people actually talked to the subjects by phone. Considering the large sampling, Gallup’s conclusions at this point in the Patient Protection and Affordable Care Act’s existence are worth noting.

“As states grapple with how to implement the Affordable Care Act,” it said, “a pattern has emerged that reveals that states with the highest rates of uninsured residents are among the least likely to expand Medicaid and to establish state-based exchanges. Utah’s apparent recent decision to expand Medicaid means that for the first time, a majority of states (plus the District of Columbia) plan to do so. Thus far, however, most states headed by Republican governors have decided against voluntary state action, preferring to pursue other means of lowering uninsured rates among their residents.”

The bottom line, Gallup concluded, is that with defections like Utah and Arkansas, Obamacare, in some form or another, will most likely continue to drive health insurance in the direction of creating access to coverage for more Americans. Nationally, 17.3 percent of U.S. adults reported being without health insurance in 2013, a percentage that has slowly increased from 14.8 percent in 2008, Gallup said.